case report dissociative disorders: between neurosis and ...neurosis and henry ey thinks of neurosis...

Case ReportDissociative Disorders: Between Neurosis and Psychosis

C. Devillé, C. Moeglin, and O. Sentissi

Department of Mental Health and Psychiatry, General Psychiatry Department, University Hospital of Geneva,CAPPI Jonction, Rue des Bains 35, 1205 Geneva, Switzerland

Correspondence should be addressed to C. Deville; [email protected]

Received 4 May 2014; Revised 17 August 2014; Accepted 15 September 2014; Published 22 October 2014

Academic Editor: Thomas Frodl

Copyright © 2014 C. Deville et al.This is an open access article distributed under theCreativeCommonsAttributionLicense, whichpermits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dissociative disorders are a set of disorders defined by a disturbance affecting functions that are normally integrated with aprevalence of 2.4 percent in industrialised countries.These disorders are often poorly diagnosed ormisdiagnosed because of sharingcommon clinical features with psychotic disorders, but requiring a very different trajectory of care. Repeated clinical situations ina crisis centre in Geneva provided us with a critical overview of current evidence of knowledge in clinical and etiopathologicalfield about dissociative disorders. Because of their multiple expressions and the overlap with psychotic disorders, we focused onthe clinical aspects using three different situations to better understand their specificity and to extend our thinking to the relevanceof terms “neurosis” and “psychosis.” Finally, we hope that this work might help physicians and psychiatrists to become more awareof this complex set of disorders while making a diagnosis.

1. Introduction

Dissociative disorders are a complex syndrome because ofmultiple expressions and the wide variety, defined by disturb-ances of every area of psychological functioning, affectingfunctions that are normally integrated such as memory, con-sciousness, identity, emotion, perception, body representa-tion, motor control, and behaviour [1].

Major changes in dissociative disorders in the recent fifthedition of DSM-5 include the following: (1) derealization isincluded in the name and symptom structure of what previ-ously was called depersonalization disorder (depersonaliza-tion-derealization disorder); (2) dissociative fugue is now aspecifier of dissociative amnesia rather than a separate diag-nosis; and (3) the criteria for dissociative identity disorderwere changed to indicate that symptoms of disruption ofidentity may be reported as well as observed and that gaps inthe recall of events may occur for everyday and not just trau-matic events. Also, experiences of pathological possessionin some cultures are included in the description of identitydisruption.

According to ICD-10, there aremore subtypes of diagnos-tic categories and depersonalization/derealization disorder isclassified in neurotic disorders (see Table 1).

These classifications admit that dissociative disordersare psychogenic, that is, of purely mental origin [2]. At thepresent time, experts on this field agree that classificationsand definitions of this disorder are insufficient [3].

The prevalence of dissociative disorders is close to 2.4percent in industrialised countries [4] and, for dissociativeidentity disorder, the prevalence is close to 1 percent [1]. Theauthors believe that these results are often undervalued [5].The sex ratio is 1 : 1 [6].

Diagnostic of dissociative disorders can overlap with psy-chotic disorders, reflecting the close relationship betweenthese diagnostic classes [7–11]. This may contribute to diag-nostic errors and therefore lead to inadequate care and treat-ment management.

The history of the concept of dissociation goes back to theworks of Charcot andBernheimonhysteria and hypnosis andthen those of Janet and Freud. With Bleuler, the concept of“dissociation” extends and is soon permanently reduced tosome symptoms of schizophrenia, known from clinicians as“Spaltung,” a psychic disintegration expressed in discordantmanifestations of thoughts, affects, and behaviour. This divi-sion contributes, even at the present time, to supply issues onthe border, sometimes blurred, between hysterical symptoms,posttraumatic stress, and schizophrenia.

Hindawi Publishing CorporationCase Reports in PsychiatryVolume 2014, Article ID 425892, 6 pageshttp://dx.doi.org/10.1155/2014/425892

2 Case Reports in Psychiatry

Table 1: Classification of dissociative disorders in ICD-10 and DSM-5.

ICD-10 DSM-5

F44.0 Dissociative amnesia 300.12 Dissociative amnesia without fugue

F44.1 Dissociative fugue 300.13 Dissociative amnesia with dissociativefugue

F44.2 Dissociative stuporF44.3 States of obsession and dissociative tranceF44.4 Dissociative motor disordersF44.5 Attacks of cramps dissociativeF44.6 Sensitivity disorders and dissociative sensoryF44.7 Mixed dissociative disordersF44.8 Other dissociative disordersF44.80 Ganser’s syndromeF44.81 Multiple personality 300.14 Dissociative identity disorderF44.89 Other specified dissociative disorders 300.15 Other specified dissociative disordersF44.9 Unspecified dissociative disorders 300.15 Unspecified dissociative disorders

F48.1 Depersonalization/derealization disorder (up toneurotic disorders) 300.6 Depersonalization disorder (up to

dissociation disorders)

“The dissociation would focus on the body representa-tion, in the direction of a separation of body and psyche (. . .)”[12]. Dissociative disorders correspond to a less archaic waythan schizophrenia, with an important sensory oppressioncomponent recognised by the evoking apprehended foreignsensations [12]. Laferriere-Simard and Lecomte [10] mentionauthors, including Janet (1894), Follin, Chazaud and Pilon(1961) who suggest the terms of madness and hysterical psy-chosis. Freud sometimes describes psychosis as an aggravatedneurosis and Henry Ey thinks of neurosis as “a first degreeof fall in psychosis” [12]. In 1993, van der Hart et al. [13]suggest the term of dissociative reactive psychosis, insteadof hysterical psychosis, diagnosed when an immersion inphenomena of traumatic origin becomes invasive for thepatients. The psychotic characteristics would decrease ordisappear when the traumatic origins are identified. In 2004,Ross and Keyes [14] suggest the existence of a distinct groupof people who suffer from schizophrenia, with dissociationas the underlying expression of psychotic symptoms and, inthis sense, they propose to create the subtype of dissociativeschizophrenia like the paranoid or the catatonic subtypes [10].We have therefore found, through the history of hysteria,that the terms psychosis and hysteria are contained in asingle concept, to mention hysterical psychosis (in ICD-10, dissociative disorder conversion is also called “hystericalpsychosis”). Since the 2000s, the new concept of dissociativeschizophrenia emerges. So we have noticed that the termdissociative is once associated with neurosis and once withpsychosis, or even both.

Moreover the dissociative disorders are frequently foundin the aftermath of trauma, correlated or not with the emo-tional life during childhood [15, 16]. This latter consider-ation, shared by dissociative disorders and schizophrenia

[17], reinforces the communal phenomenological aspects andcomplicates the differentiation between these two clinicalentities. Many of the symptoms, including embarrassmentand confusion about the symptoms or desire to hide them,are influenced by the proximity to trauma. In DSM-5, thedissociative disorders are placed next to, but are not partof, the trauma- and stressor-related disorders, also reflectingthe close relationship between these diagnostic categories.Both acute stress disorder and posttraumatic stress disordercontain dissociative symptoms, such as amnesia, flashbacks,numbing, and depersonalization/derealization.

We have evaluated and managed several clinical cases ofdissociative disorders in the crisis centre of area-catchmentof Jonction in Geneva, each one with distinct causes. Torefine the diagnosis and optimise the care management ofthese clinical cases, we have performed a critical overview ofcurrent computerized evidence of knowledge (Medline).

2. Clinical Vignettes

2.1. Clinical Vignette Number 1. Mr. A is a 32-year-old patientof Swiss origin. He works as an insurer. He has a partnerwhom he has been with for over 2 years and with whom hehad a child. He talks about sexual abuse from one member ofhis own family members in the past but has only vaguemem-ories of this event. A diagnosis of paranoid schizophrenia wasestablished 6 years ago, and the patient has been in remissionfor 5 years without antipsychotic treatment. The patient hascontacted us to request a diagnostic evaluation in the contextof a development.

With regard to mental status, the patient is calm andcollaborating; his thoughts have an organised structure; he iswell-oriented, and his hygiene and clothing are appropriate.

Case Reports in Psychiatry 3

His thymia is neutral and there are no elements of depressivesymptomatology. His speech is coherent, fluid, and informa-tive without delusional elements. His only “psychosis-like”symptomatology is the “voice hearings” in the form of voicesthat speak to him from within. He determines that thesevoices are coming from his own imagination.

Indeed, he describes constant oscillations between thepresence of two distinct personalities, which he manages todifferentiate. The first personality is described as that of ajunkie (if he does not control himself, he lives as a personwho needs to consume drugs and he goes into hiding in unin-habited buildings), and the other personality is described asthat of a conformist modern man (i.e., clean looking, “wellthinking,” and conforming to society’s standards; an attitudehe adopts elsewhere, at work, for example).

His mental status reveals the characteristics of a dis-sociative identity disorder. There are two distinct identitiesor “States of personality” in this patient; they take turns atcontrolling the behaviour of the patient. The disturbance isnot due to the direct effects of a substance or a generalmedicalcondition. Moreover, he does not have psychotic sympto-matology. He describes that the voices are coming from theinside of himself (each of the personalities interacts with him,alternately). He has no other comorbid disorder. He has onemeeting a month for supportive psychotherapy. He is nottreated with psychotropic medication.

2.2. Clinical Vignette Number 2. Mrs. B is a 44-year-oldpatient who has been married for 24 years; she lives withher husband and their 2 teenage children. She has no knownpsychiatric history. The authority of parenting has been atraumatic experience, and she has a self-assertion deficit.

She consulted the psychiatric emergency department in2012, accompanied by her family. She presented with a behav-iour disorder of gradual emergence, in the form of psycho-motor agitation and “sexual” exhibition. She also had voicehearings (she hears from “an angel” coming from inside thatpredicts upcoming events and guides her). The self-criticismis retained. The emergency psychiatrist felt that this was apsychotic disorder not otherwise specified; he administeredan anxiolytic medication (lorazepam) to quickly tranquilisethe patient and transferred her to the crisis centre. Uponadmission, the patient had significantly intense anxiety, hada situational mild to moderate spatiotemporal disturbance,and was confused. Her mood was sad, with minor anhedoniaand minor abulia. She had a sleep disorder for three days,with insomnia at the beginning and at the end of the night.Her speech was coherent, informative, fluid, and critical inthe aftermath (she says that she hears the voice of an angel,which she identifies as a production of her own imagination).Considering the persistent “psychosis-like” and mass anxietysymptomatology, antipsychotic treatment with olanzapinewas administered, and it was recommended that the patientstays a few nights in the centre for further care. The presenceof a comorbid depressive disorder (MADRS scale score of 19)led us to prescribe an antidepressant treatment, trazodone;the dose was increased gradually to 200mg per day. The“psychosis-like” symptomatology started improving quickly,

within 48 h, and the antipsychotic treatment was stopped.The patient was able to return home after 3 days and wasfollowed up every week with two interview sessions. Duringher followup, thymic improvement was noted, with a returnof the vital impetus and a decrease in the anxiety but withthe emergence of a diffuse painful syndrome. Her treatmentis one-session psychotherapy per week and trazodone 200mgper day.

2.3. Clinical Vignette Number 3. Mrs. C is a 33-year-oldpatient who is a law graduate. She is married and does nothave any children. She presented with a major depressivedisorder of moderate intensity, generalised anxiety, and ahistory of alcohol dependence (having been sober for afew months). She was hospitalised for the first time in thepsychiatric department for 10 days, a few weeks before wemet her, due to a diagnosis of “acute and transitory psychoticdisorder” (with voice hearings and a behavioural disorderthat has medicolegal impacts), which has been linked todisulfiram treatment; the evolution of this disorder has beenfavourable with olanzapine 10mg/day and then quetiapine200mg/day, in addition to the usual treatment of venlafaxine75mg/day. Subsequently, this patient was treated in ourambulatory unit, where risperidone 1mg/day was prescribed,and then she was hospitalised again in the psychiatric clinicfor one month. Venlafaxine was replaced by escitalopram.The dose of escitalopram was decreased to 30mg/day as aresult of an increase in her liver enzymes. We also substitutedpregabalin for olanzapine 5mg/day (which was reintroducedduring the 2nd hospitalisation), because of increased feelingsof depersonalization-derealization, which means a feeling of“getting out of her body,” which she described “as if ” shewas an automaton and having recurring feelings of beingdetached from herself. The patient had an improvementin her depressive symptomatology (MADRS score of 32 atadmission and 12 over the course of treatment) under esc-italopram 30mg/day and pregabalin 200mg/day. However,there was a persistence of moderate anxiety. She did not haveany psychotic symptomatology. She benefitted from analyti-cal psychotherapy with one meeting per week.

3. Discussion

The growing clinical interest in the different forms of dis-sociative disorders has led us to carry out a brief review ofthe literature, supported by three clinical cases to highlightthis complex disorder. Dissociative disorders are difficultto distinguish from psychotic disorders not only becauseof the close proximity of phenomenological elements butalso because of a linked aetiology due to trauma, triggeringsometimes both disorders. This is further complicated byother comorbid disorders, which are often present. Authorshave reported association with an anxiety disorder [18–21],a depressive state [19, 20], a borderline personality disorder,PTSD, or substance abuse (in 83 to 96% of cases of dissocia-tive identity disorders) [1] and comorbid somatoform disor-ders (headache, in 79 to 91% of cases of dissociative identitydisorders, conversion syndromes, and somatoform disordersin 35 to 61% of cases of dissociative identity disorders) [1].


We noted that Mrs. B presented conversion symptoms(formerly classified as hysterical), which were theatrical(there was powerful staging in front of her family) with sexualthematic (showing off nude in front of her close relationsand people in her immediate environment), and she hadvoice hearings (pseudohallucinations) [22, 23]. The latterwere described as arising from the inside (and not from theoutside); in fact the morbid conscience was retained; shecriticised these voices by explaining they were produced byher imagination. This patient reported becoming an outsideobserver of her own body with a sense of being in a dreamwhile maintaining an intact appreciation of reality, after fol-lowing treatment andwith a refinement of diagnostic criteria.These symptoms and their clinical and therapeutic progres-sion (she had good anxiolysis with lorazepam) helped usto diagnose a specified dissociative disorder. The developeddiagnostic could have led us to make an incorrect diagnosisof a brief psychotic disorder if we had not investigated for thepresence of dissociative disorder. The diagnosis of dissocia-tive disorder had a real impact on the patient’s treatment.

However, there are only limited data on the effectivenessof drug treatments for dissociative disorders. The psycho-pharmacological approach is the foremost treatment basedon the presence of other comorbidities. Selective serotoninreuptake inhibitors (SSRIs) treatment allows for the reductionof comorbidities, such as anxiety and depressive symptoms,although SSRIs have little effect on the dissociative disorderitself. We treated the patient with an antidepressant to reduceboth the depressive and anxiety symptomatology and thepains associated with the symptoms. Psychotherapeutic sup-port was given in the form of psychodynamic and systemicinspiration.

The symptoms Mr. A presented were likely to generate adiagnostic error, being the differential diagnosis between apsychotic disorder and a dissociative disorder close in thiscase.We established a diagnosis of dissociative identity disor-der for this patient, whowas previously diagnosedwith schiz-ophrenia. In fact, 25 to 50% of people diagnosed with adissociative disorder are already affected by schizophrenia[24]. Voice hearings, for example, are found in 73% of schizo-phrenia cases [25] and in 82 to 87% of dissociative identitydisorder cases [26]. In a 2005 paper, Kluft [27] describesthat, for people suffering from a dissociative identity disorder,80% of cases perceive their voice hearings as coming frominside of themselves (pseudohallucinations), whereas, forpeople suffering from psychosis, 80% of cases perceive theirvoice hearings as coming from an external source (auditoryhallucinations). Mr. A’s medical files stated that he neverhad a disruption of behaviour nor significant delirium fora period longer than one month. This is important becausethese patients tend to spend more time in the health caresystem. In fact, they have a diagnosis and treatments whichare often poorly adapted [28]. This patient did not accept apsychoactive treatment. In this case, a supportive effectivetherapy with attentive listening was the adequate treatmentwithout comorbidity.

Concerning the treatment of Mrs. C, she had received adiagnosis of acute and transitional psychotic disorder treatedwith an antipsychotic treatment.However, thiswas called into

question due to the traced history of the postcrisis symp-tomatology. She described feeling detached from herself, of“getting out of her own body,” she described voices heardinternally (pseudohallucinations), and she retained morbidconscience, in the context of mass anxiety. These elementsenabled us to diagnose a depersonalization-derealization dis-order, which is a dissociative disorder according to DSM-5but which is considered as a neurotic trouble in ICD-10. Con-cerning patients with depersonalization-derealization, theyfrequently use the expression “it is as if ” [29, 30] to describethe state of their symptomatology. She presented comorbiddisorders: a major depressive disorder associated with a gen-eralised anxiety.

This patient received treatment with pregabalin for gen-eralised anxiety and a selective serotonin reuptake inhibitor(escitalopram) for major depressive disorder but receivedno other treatment for the depersonalization-derealizationdisorder. Antipsychotic drugs are sometimes used to treatthe depersonalization-derealization disorder; however, theireffectiveness has not been demonstrated in any controlledstudy, and the emergence of depersonalization-derealizationhas been reported under antipsychotics [31, 32]. It is possiblethat the antipsychotic treatment she received previouslycould have enhanced this syndrome subsequently. The psy-chotherapy established for this patient was based on both thepsychodynamic and systemic approaches.

The therapeutic approaches used for dissociative disor-ders correspond to the three basic models: cognitive-behav-ioural, psychodynamic, and systemic therapy. Psychothera-peutic treatments, which appear to be the most effective sofar, are the EMDR [33], the psychodynamic approach [33, 34],and attentive listening to the words of the patient [34]. A fewsystemic approaches (of narrative inspiration, e.g.) provideinteresting perspectives [35].

We assume that it is important to distinguish voice hear-ings experiences coming from inside (pseudohallucinations)in the dissociative disorder from those coming from outside(auditory hallucinations) in psychosis.

We have identified that dissociative disorders are a kindof trouble close to psychotic disorders because of voice hear-ings experiences inter alia. The “psychosis-like” symptoms(behavioural disorders, agitation, (auditory) pseudohalluci-nations, and pseudodelusions) are a part of dissociative dis-order, giving this diagnosis hard to make. Other “psychosis-like” symptoms are the confusion and the impression to be ina “dream,” to be detached from feelings and to live something“as if.” We are aware that this is specific of depersonalization-derealization disorder, a dissociative disorder according tothe DSM-5.

Finally, the specific symptoms we described in this paperallowed us suggesting that dissociative disorders are a set oftroubles at the border between neurosis and psychosis. Themain question of this work was to know if the dissociativedisorders belong to the group of neurosis or to the one ofpsychosis. Are they on the border between these two entitiesas the clinical symptomatology and the history show us? Thefact that this disorder frequently appears among patients,especially with a borderline personality disorder, points theargumentation of this discussed border leading to prospects

Case Reports in Psychiatry 5

for theoretical model of dissociative personality structure[36]. If we agree that dissociative disorder shares the sameconcept of hysteria which is a neurosis, that ICD-10mentionsthe term “hysterical psychosis,” and also that depersonaliza-tion-derealization disorder is considered as a neurotic disor-der even when we identify that it presents “psychosis-like”symptoms, this means that there is neurosis in psychosis andvice versa and thus that dissociative disorders are a separateentity. Concerning perspectives theories, it would be inter-esting to develop the idea that neurosis and psychosis areprecarious terms, as the boundary between both is becomingincreasingly blurred.

4. Conclusion

Adequate and well-adapted therapeutic treatment for theseclinical cases of dissociative disorders has resulted in afavourable outcome in our crisis centre. We have identifiedthat dissociative disorders are a kind of trouble close topsychotic disorders on one hand, because of voice hearingexperiences inter alia, and close to neurotic disorders on theother hand, because of intact reality testing inter alia. Wetherefore suggest keeping focus on descriptive clinical symp-tomatology in this case. Further clinical studies, theoreticalapproaches, and reflections about this complex disorder aresuitable.

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper.

Acknowledgment

Theauthorswould like to thank all themultidisciplinary teamof the mental health catchment of Jonction who gave themtheir help to do this work and who gives everyday optimalcare to patients.

References

[1] B. Foote, “Dissociative identity disorder: epidemiology, path-ogenesis, clinical manifestations, course, assessment, and diag-nosis,” Uptodate.com, Consulte le 9 aout 2014, Disponible al’adresse, http://www.uptodate.com/contents/dissociative-iden-tity-disorder-epidemiology-pathogenesis-clinical-manifesta-tions-course-assessment-and-diagnosis.

[2] C. Docquir, “The symptoms medically unexplained: clarifica-tion of terminology, epidemiological data among the adult andthe child, overview of against-attitudes,” Bulletin of Psychology,vol. 523, pp. 61–75, 2013.

[3] H. Dellucci and H. Mattheß, “Troubles dissociatifs. Theorie etdiagnostic,” Essentia.fr [en ligne]. [Consulte le 5 aout 2014].Disponible a l’adresse, http://www.essentia.fr/blog/wp-content/uploads/2011/10/MatthessDellucci-2011-TheorieDiagnostic-dis-sociation-structurelle.pdf.

[4] C. A. Ross, “Epidemiology of multiple personality disorder anddissociation,” Psychiatric Clinics of North America, vol. 14, no. 3,pp. 503–517, 1991.

[5] N. Hunter, Understanding Dissociative Disorders: A Guide forFamily Physicians and Healthcare Professional, Reviewed byN. L. Wilson, M.D., Private Practice, Washington, DC, USA,Crown House Publishing, Williston, Vt, USA, 2004.

[6] D. Baker, E. Hunter, E. Lawrence et al., “Depersonalisation dis-order: clinical features of 204 cases,” British Journal of Psychia-try, vol. 182, pp. 428–433, 2003.

[7] M. J. Dorahy, C. Shannon, L. Seagar et al., “Auditory halluci-nations in dissociative identity disorder and schizophrenia withand without a childhood trauma history: s0imilarities and dif-ferences,” Journal of Nervous andMental Disease, vol. 197, no. 12,pp. 892–898, 2009.

[8] D. Freeman and D. Fowler, “Routes to psychotic symptoms:trauma, anxiety and psychosis-like experiences,” PsychiatryResearch, vol. 169, no. 2, pp. 107–112, 2009.

[9] S. R. Jones, “Dowe needmultiplemodels of auditory verbal hal-lucinations? examining the phenomenological fit of cognitiveand neurological models,” Schizophrenia Bulletin, vol. 36, no. 3,pp. 566–575, 2010.

[10] M.-C. Laferriere-Simard and T. Lecomte, “Does dissociativeschizophrenia exist?” Sante Mentale Quebec, vol. 35, no. 1, pp.111–128, 2010.

[11] S. Perona-Garcelan, F. Carrascoso-Lopez, J. M. Garcıa-Monteset al., “Depersonalization as amediator in the relationship betweenself-focused attention and auditory hallucinations,” Journal ofTrauma and Dissociation, vol. 12, no. 5, pp. 535–548, 2011.

[12] O. Revaz and F. Rossel, ““Hysterical dissociation” and schiz-ophrenic splitting: the contribution of projective techniques,”Psychologie Clinique et Projective, vol. 13, pp. 93–122, 2007.

[13] O. van der Hart, E.Witztum, and B. Friedman, “From hystericalpsychosis to reactive dissociative psychosis,” Journal of Trau-matic Stress, vol. 6, no. 1, pp. 43–64, 1993.

[14] C. A. Ross and B. Keyes, “Dissociation and schizophrenia,” Jour-nal of Trauma & Dissociation, vol. 5, no. 3, pp. 69–83, 2004.

[15] W. E. Lee, C. H. T. Kwok, E. C. M. Hunter, M. Richards, and A.S. David, “Prevalence and childhood antecedents of deperson-alization syndrome in a UK birth cohort,” Social Psychiatry andPsychiatric Epidemiology, vol. 47, no. 2, pp. 253–261, 2012.

[16] M. Shevlin, M. R. Dorahy, and G. Adamson, “Childhood trau-mas andhallucinations: an analysis of theNationalComorbiditySurvey,” Journal of Psychiatric Research, vol. 41, no. 3-4, pp. 222–228, 2007.

[17] S. Perona-Garcelan, J. M. Garcıa-Montes, C. Cuevas-Yust et al.,“A preliminary exploration of trauma, dissociation, and positivepsychotic symptoms in a spanish sample,” Journal of Traumaand Dissociation, vol. 11, no. 3, pp. 284–292, 2010.

[18] L. Mendoza, R. Navines, J. A. Crippa et al., “Depersonalizationand personality in panic disorder,” Comprehensive Psychiatry,vol. 52, no. 4, pp. 413–419, 2011.

[19] M. Michal, H. Glaesmer, R. Zwerenz et al., “Base rates fordepersonalization according to the 2-item version of the Cam-bridge Depersonalization Scale (CDS-2) and its associationswith depression/anxiety in the general population,” Journal ofAffective Disorders, vol. 128, no. 1-2, pp. 106–111, 2011.

[20] M. Michal, J. Wiltink, Y. Till, P. S. Wild, M. Blettner, and M. E.Beutel, “Distinctiveness and overlap of depersonalization withanxiety and depression in a community sample: results from theGutenberg Heart Study,” Psychiatry Research, vol. 188, no. 2, pp.264–268, 2011.

[21] M. Sierra, N. Medford, G.Wyatt, and A. S. David, “Depersonal-ization disorder and anxiety: a special relationship?” PsychiatryResearch, vol. 197, no. 1-2, pp. 123–127, 2012.


[22] R. S. El-Mallakh and K. L. Walker, “Hallucinations, psuedohal-lucinations, and parahallucinations,” Psychiatry, vol. 73, no. 1,pp. 34–42, 2010.

[23] E. Longden, A. Madill, and M. G. Waterman, “Dissociation,trauma, and the role of lived experience: toward a new concep-tualization of voice hearing,” Psychological Bulletin, vol. 138, no.1, pp. 28–76, 2012.

[24] C. A. Ross, Dissociative Identity Disorder: Diagnosis, ClinicalFeatures, and Treatment of Multiple Personality, John Wiley &Sons, New York, NY, USA, 2nd edition, 1997.

[25] A. T. Beck and N. A. Rector, “A cognitive model of hallucina-tions,” Cognitive Therapy and Research, vol. 27, no. 1, pp. 19–52,2003.

[26] C. A. Ross, S. D. Miller, P. Reagor, L. Bjornson, G. A. Fraser, andG. Andersen, “Structured interview data on 102 cases of multi-ple personality disorder from four centers,”American Journal ofPsychiatry, vol. 147, no. 5, pp. 596–601, 1990.

[27] R. P. Kluft, “Diagnosing dissociative identity disorder,” Psychi-atric Annals, vol. 35, no. 8, pp. 633–643, 2005.

[28] C. A. Ross and G. R. Norton, “Multiple personality disorderpatients with a prior diagnosis of schizophrenia,” Dissociation,vol. 1, no. 2, pp. 39–42, 1988.

[29] H. M. Solomon, “Self creation and the limitless void of dissoci-ation: the “as if ” personality,” Journal of Analytical Psychology,vol. 49, no. 5, pp. 635–656, 2004.

[30] N. Medford, M. Sierra, D. Baker, and A. S. David, “Under-standing and treating depersonalisation disorder,” Advances inPsychiatric Treatment, vol. 11, no. 2, pp. 92–100, 2005.

[31] R. Brauer, M. Harrow, and G. J. Tucker, “Depersonalizationphenomena in psychiatric patients,” The British Journal ofPsychiatry, vol. 117, no. 540, pp. 509–515, 1970.

[32] J. Sarkar, N. Jones, andG. Sullivan, “A case of depersonalization-derealization syndrome during treatment with quetiapine,”Journal of Psychopharmacology, vol. 15, no. 3, pp. 209–211, 2001.

[33] H. J. Freyberger and C. Spitzer, “Dissociative disorders,” Nerve-narzt, vol. 76, no. 7, pp. 893–899, 2005.

[34] V. Boucherat-Hue, “L’archaıque des nevroses a l’epreuve despsychotherapies psychanalytiques,” Psychotherapies, vol. 22, pp.213–228, 2002.

[35] H.Delucci andC. Bertrand, “Le collage de la famille symboliqueet approche narrative. Une voie alternative pour constituer unlien d’attachement et une identite en lien avec les valeurs exis-tentielles,”Therapie Familiale, vol. 33, pp. 337–355, 2012.

[36] O. van der Hart, E. R. S. Nijenhuis, and K. Steele,The HauntedSelf: Structural Dissociation and the Treatment of Chronic Trau-matization, Norton Series on Interpersonal Neurobiology, W.W. Norton & Company, 2006.

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